Vinorelbine as substitute for vincristine in patients with diffuse large B cell lymphoma and vincristine-induced neuropathy
Open Access
- 31 August 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Supportive Care in Cancer
- Vol. 29 (9), 5197-5207
- https://doi.org/10.1007/s00520-021-06059-2
Abstract
Background A combination of rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is the standard first-line therapy for diffuse large B cell lymphoma (DLBCL), the most common aggressive lymphoma in adults. One of the major adverse effects of this regimen is vincristine-induced polyneuropathy which leads to discontinuation of vincristine in up to 30% of DLBCL-patients. Dose reduction of vincristine might worsen treatment outcomes of DLBCL but identification of treatment alternatives for patients exhibiting peripheral neuropathy during R-CHOP is an unmet need in hematology. Methods In this retrospective cohort study, comprising 987 patients with de novo DLBCL, we delineated the role of vinorelbine as a substitute for vincristine in R-CHOP by measuring improvements in neuropathy and outcome variables. Results Five-year overall survival (OS) and progression-free survival (PFS) were 72.6% and 63.1% in patients who received regular doses of vincristine, as compared to 60.6% and 51.7% in patients who received reduced doses of vincristine (p = 0.022 and p = 0.003, respectively). Of 199 patients who switched to vinorelbine, the majority experienced an improvement of neuropathy Furthermore, vinorelbine-switched patients showed favorable oncologic outcomes. Conclusion Replacement of vincristine by vinorelbine due to neuropathy is effective and safe, and results in a significant improvement in neuropathy as compared to treatment with R-CHOP.Keywords
Funding Information
- Medical University of Graz
This publication has 45 references indexed in Scilit:
- The chemotherapy-induced peripheral neuropathy outcome measures standardization study: from consensus to the first validity and reliability findingsAnnals Of Oncology, 2012
- Phase III trial of CHOP-21 versus CHOP-14 for aggressive non-Hodgkin’s lymphoma: final results of the Japan Clinical Oncology Group Study, JCOG 9809Annals Of Oncology, 2011
- Long-term outcome of patients in the LNH-98.5 trial, the first randomized study comparing rituximab-CHOP to standard CHOP chemotherapy in DLBCL patients: a study by the Groupe d'Etudes des Lymphomes de l'AdulteBlood, 2010
- Chemotherapy-Induced Peripheral Neurotoxicity assessment: A critical revision of the currently available toolsEuropean Journal Of Cancer, 2010
- Impact of relative dose intensity (RDI) in CHOP combined with rituximab (R-CHOP) on survival in diffuse large B-cell lymphomaJournal of Experimental & Clinical Cancer Research, 2009
- Effect of race on vincristine‐associated neurotoxicity in pediatric acute lymphoblastic leukemia patientsPediatric Blood & Cancer, 2007
- The Total Neuropathy Score as an assessment tool for grading the course of chemotherapy‐induced peripheral neurotoxicity: comparison with the National Cancer Institute‐Common Toxicity ScaleJournal of the Peripheral Nervous System, 2007
- Combination chemotherapy with gemcitabine and vinorelbine in the treatment of relapsed or refractory diffuse large B-cell lymphoma: a phase-II trial by the Hellenic Cooperative Oncology GroupEuropean Journal of Haematology, 2005
- Long term effects of vincristine on the peripheral nervous systemJournal of Neuro-Oncology, 1993
- Hydroxyldaunomycin (adriamycin) combination chemotherapy in malignant lymphomaCancer, 1976